Friday, October 31, 2008

Teeny tiny diapers

Since Zari has a baby doll, I decided that the doll needed diapers--cloth ones of course! I pulled out scraps from making Zari's diapers and concocted a tiny pattern to fit her doll. Here are some pictures of the bamboo velour AIO diapers in progress.

Keep your eyes out for a pattern! I just need to draw out a nice-looking one and scan it in. Mine has Zari scribbles all over it. The diaper fits a baby doll that is around 12" long.

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2 years old!

Happy Birthday Zari!

We had a lazy morning in bed together. Zari has been sleeping with us the last two nights because she's had a fever and I wanted to keep an eye on her at night. I opened the blinds this morning to take a picture and she groaned, half asleep, "bright."

More pictures to come throughout the day. She's busy playing with her new toys: a baby doll from my mom, a set of wooden stacking blocks from my mom, and a carousel push toy from us. Eric was very reluctant to let her have a doll, but frankly I don't care. It would be just as silly to forbid her to play with "girl" toys as with "boy" toys. Plus I think it will help her when the new baby comes, so she can have her own baby to take care of instead of always wanting me to baby her.
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Thursday, October 30, 2008

How breastmilk transfers immunity

Breastmilk, not to mention the women's bodies that produce it, is an amazing substance. A team of researchers from three universities (one was my alma mater, and another could have been my alma mater, but I turned it down) recently identified a molecule that enables mothers to pass certain immunities to their babies through their breast milk.

How Breastfeeding Transfers Immunity To Babies
ScienceDaily (Oct. 27, 2008) —

A BYU-Harvard-Stanford research team has identified a molecule that is key to mothers’ ability to pass along immunity to intestinal infections to their babies through breast milk.

The study highlights an amazing change that takes place in a mother’s body when she begins producing breast milk. For years before her pregnancy, cells that produce antibodies against intestinal infections travel around her circulatory system as if it were a highway and regularly take an “off-ramp” to her intestine. There they stand ready to defend against infections such as cholera or rotavirus. But once she begins lactating, some of these same antibody-producing cells suddenly begin taking a different “off-ramp,” so to speak, that leads to the mammary glands. That way, when her baby nurses, the antibodies go straight to his intestine and offer protection while he builds up his own immunity.

This is why previous studies have shown that formula-fed infants have twice the incidence of diarrheal illness as breast-fed infants.

Until now, scientists did not know how the mother’s body signaled the antibody-producing cells to take the different off-ramp. The new study identifies the molecule that gives them the green light....

Read the rest of the article here.
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Evidence-Based Practices for the Fetal to Newborn Transition

I've been going through my files and came across this article that I haven't posted yet. Email me if you'd like the full text. I've included a few excerpts from the full text, as well as the article's abstract.

Evidence-Based Practices for the Fetal to Newborn Transition
Judith S. Mercer, CNM, DNSc, Debra A. Erickson-Owens, CNM, MS,
Barbara Graves, CNM, MN, MPH, and Mary Mumford Haley, CNM, MS
Journal of Midwifery and Womens Health 52 (2007): 262–272.

The transition from fetus to newborn is a normal physiologic and developmental process—one that has occurred since the beginning of the human race. Many hospital routines that are used to assess and manage newborns immediately after birth developed because of convenience, expediency, or habit, and have never been validated. Some practices are so ingrained that older traditional practices, such as providing skin-to-skin care or delaying cord clamping, must be considered “experimental” in current studies. However, recent research is beginning to identify some older practices that should not have been abandoned and some current practices that should be stopped. In order to achieve a gentle, physiologic birth and family-centered care of the newborn, practices that might interfere with maternal and newborn bonding need to be closely scrutinized. This article examines the evidence about practices related to the newborn transition, including the effects of various drugs used labor, umbilical cord clamping, thermoregulation, suctioning, and resuscitation of the newborn.

An important tenet of practice for all health care personnel is to first do no harm. This idea takes on additional importance when dealing with newborns, as there is almost no long-term data on the safety of many procedures. No clear conclusions can be drawn from studies on maternal analgesia effects on the newborn; thus, judicious use of medications in labor is recommended with further study of better biobehavioral assessment tools to differentiate outcomes. Delaying clamping of the umbilical cord appears to offer protection from anemia without harmful effects. The practice of immediate clamping, especially with a nuchal cord, should be discontinued. The evidence suggests that skin-to-skin care of the newborn after birth and during the first hour of life should be the mainstay of newborn thermoregulation and care. Routine suctioning of the infant at birth should be abandoned. Meconium-stained babies should not be suctioned on the perineum and vigorous infants should not be intubated and suctioned. There is no evidence that
amnioinfusion prevents meconium aspiration syndrome. The mounting evidence suggests that use of 100% oxygen at birth to resuscitate newborns may cause harmful effects. Room air is permissible for the first 90 seconds with oxygen available if there is not an appropriate response in that time.

Routine interventions, such as suctioning the airway or stomach or using 100% oxygen for resuscitation, or immediate clamping of the umbilical cord, have never based on any clear evidence that they improve newborn care or outcomes. Yet some of these practices are so firmly entrenched that it will take a large body of research to change the standard. We must continue to
build a body of knowledge that supports the evidence: more often than not, less intervention is better.

Many common care practices during labor, birth, and the immediate postpartum period impact the fetal to neonatal transition, including medication used during labor, suctioning protocols, strategies to prevent heat loss, umbilical cord clamping, and use of 100% oxygen for resuscitation. Many of the care practices used to assess and manage a newborn immediately after birth have not proven efficacious. No definitive outcomes have been obtained from studies on maternal analgesia effects on the newborn. Although immediate cord clamping is common practice, recent evidence from large randomized, controlled trials suggests that delayed
cord clamping may protect the infant against anemia. Skin-to-skin care of the newborn after birth is recommended as the mainstay of newborn thermoregulation and care. Routine suctioning of infants at birth was not been found to be beneficial. Neither amnioinfusion, suctioning of meconium-stained babies after the birth of the head, nor intubation and suctioning of vigorous infants prevents meconium aspiration syndrome. The use of 100% oxygen at birth to resuscitate a newborn causes increased oxidative stress and does not appear to offer benefits over room air. This review of evidence on newborn care practices reveals that more often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn.
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Tuesday, October 28, 2008


I think our house has a serious insulation problem--as in, lack thereof. The thing is, I can't really check to see if our attic areas are insulated because most of the attic spaces have no access hole. Our house has a really strange roofline, and most of the rooms have their own roof & attic space. In other words, there's not one big roofline/attic over all the rooms like you'd have in a normal house. Two of the rooms have attic floorboards overhead, and from what I can see in the gaps between the boards, there's a really scant amount of insulation. So I have a feeling we'll be ripping out attic floorboards in order to blow insulation over some of the rooms, cutting holes in walls and/or ceilings to get to the rest, and generally making a mess in order to get the house warmer.

The basement and crawl spaces are also uninsulated. I think that adding insulation to the basement ceilings and ductwork will help as well, but they are not as crucial as the attic insulation. I can't do anything about the walls because they are all solid brick.

I am also trying to conserve energy by keeping the temperatures lower indoors. The front two rooms are at 66 during the day, while the rest of the house stays around 60-62 degrees. I have oil-filled electric radiators in those two front rooms so I don't have to heat the entire house all day. At night the radiators are turned off and the thermostat is set at 60 degrees. I have a really hard time maintaining my body temperature with these settings, especially if I go into any of the other rooms. I typically wear a long sleeve shirt, a sweater, and a large fleece pullover. I heat up rice socks in the microwave and drink hot herbal teas and put blankets on when I am sitting down. And I still am really cold much of the day.
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Saturday, October 25, 2008

Effects of maternity care practices on breastfeeding

The October 2008 issue of Pediatrics has a supplement devoted to the topic of breastfeeding. Among the many articles was a study of how maternity care practices affect breastfeeding. The study used recent CDC data on infant feeding practices (Infant Feeding Practices II).

The researchers found a strong association between "Baby-Friendly" practices and longer duration of breastfeeding. Mothers who experienced no Baby-Friendly practices, compared to mothers who received all six that the study examined, were thirteen times more likely to stop breastfeeding early. The most significant practices were initiation of breastfeeding within the baby's first hour of life, giving only breast milk, and not using pacifiers.

Below is the abstract from the study; email me if you'd like the full text of the article.

Effect of Maternity-Care Practices on Breastfeeding
Ann M. DiGirolamo, PhD, MPH, Laurence M. Grummer-Strawn, PhD and Sara B. Fein, PhD.
Pediatrics 122 (2008): S43-S49

OBJECTIVE. Our goal was to assess the impact of "Baby-Friendly" hospital practices and other maternity-care practices experienced by mothers on breastfeeding duration.

METHODS. This analysis of the Infant Feeding Practices Study II focused on mothers who initiated breastfeeding and intended prenatally to breastfeed for >2 months, with complete data on all variables (n = 1907). Predictor variables included indicators of 6 "Baby-Friendly" practices (breastfeeding initiation within 1 hour of birth, giving only breast milk, rooming in, breastfeeding on demand, no pacifiers, fostering breastfeeding support groups) along with several other maternity-care practices. The main outcome measure was breastfeeding termination before 6 weeks.

RESULTS. Only 8.1% of the mothers experienced all 6 "Baby-Friendly" practices. The practices most consistently associated with breastfeeding beyond 6 weeks were initiation within 1 hour of birth, giving only breast milk, and not using pacifiers. Bringing the infant to the room for feeding at night if not rooming in and not giving pain medications to the mother during delivery were also protective against early breastfeeding termination. Compared with the mothers who experienced all 6 "Baby-Friendly" practices, mothers who experienced none were 13 times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination.

CONCLUSIONS. Increased "Baby-Friendly" hospital practices, along with several other maternity-care practices, improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to implement these practices continues to exist, as illustrated by the small proportion of mothers who reported experiencing all 6 of the "Baby-Friendly" hospital practices measured in this study.
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Thursday, October 23, 2008

My local hospital

I learned some interesting (disturbing?) information about my local hospital when I met with the CNM two days ago. She worked there a few years back while she was doing her nurse/nurse-midwifery degrees and finally left because she didn't like what she saw going on. A few examples:
  • The hospital had a mandatory 24-hour nursery stay for all newborns. (She doesn't know if this is still the case today; I will definitely investigate this.)
  • A woman asked the hospital's CNM how long she should breastfeed, and the midwife responded, "it's not culturally acceptable to breastfeed longer than 6 months."
  • This same CNM dropped a woman from care for refusing a gestational diabetes screen.
  • The nurses often gave out nipple shields to new mothers although they were not needed or warranted.
Yikes! I have a new project to work on: getting the hospital to become Baby-Friendly certified and, down the road, Mother-Friendly. Watch I come! (Well, after the dissertation is done.)

This is a hospital that advertises its "5-star accomodations." It uses the typical cheesy marketing techniques to draw in potential customers (not like we have any other choices--it's the only hospital in town):
[Our] updated facilities and amenities more closely resemble that of a fine resort than that typically associated with a local community hospital. That’s because our newly renovated LDRP suites were designed to soothe and calm both mother and baby....

Enjoy All the Comforts of Home
We like to call our Maternity Care Center “state of the heart” because we combine the most modern technology with our unrivaled personal attention. We listen closely to our mothers and their birthing needs, because we want their delivery to be as unique as their new bundle of joy....

Begin Parenthood in Style
The inviting nature of the LDRP (labor/delivery/recovery/postpartum) suites is designed to ease anxieties while calming the spirit of both mother and baby. The new atmosphere encourages mothers to begin bonding with their baby immediately after birth, all in a room equipped with the latest technology, so you enjoy the comforts of being at home at a location not far from your home....

Celebrating New Life
During your maternity stay, you and your birth partner will be treated to a celebration meal, as well as a new baby care package. Before you leave for home, our nurses will provide you with informational materials about feeding your baby, caring for your newborn and caring for yourself.

Can't you just hear the schmaltzy violins in the background?
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I'd like to listen to the Hypnobabies CDs this pregnancy. Before I go out and buy a brand new set, I thought I'd ask if any of you readers would lend me your set to check out. I will pay for shipping and send them back promptly. Pretty please?
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Wednesday, October 22, 2008

Birth plans

I am not sure yet about what my plans will be for this birth. Barring a pressing medical need for hospital care, I will give birth at home. That's a no-brainer. But whether I will do it unassisted or hire a midwife is up in the air. During Zari's pregnancy, I felt very drawn to an unassisted birth, while having a midwife did not feel right. This time around, I don't have a clear sense yet. I find myself wanting to have more options than UC or the ER. My ideal would be to have an undisturbed birth with a supportive midwife on call, waiting somewhere if I wanted her assistance but not managing the birth or getting in my way. Basically if I could beam Pamela out here, I would!

I want to have a midwife available for these main reasons:
  • assess for tears and suture/Dermabond if necessary
  • do my Rh- bloodwork and write a Rx for Rhogam if needed
  • assist in the case of a shoulder dystocia or rapid postpartum hemorrhage
I met with a midwife yesterday, a CNM who attends home births. I really liked her and felt very comfortable with her. We talked about both of our expectations for the birth and where we could meet. I knew she probably wouldn't be comfortable doing no heart tone checks at all, and I was right. I had hoped that she would be okay otherwise staying in another room, even when the baby was born, but she does want to be present for the birth itself to keep an eye on things. She says she is usually pretty hands-off at births; I'd like to talk with her more about what this means in practice. She does understand my need for privacy, as she herself also craves solitude during labor.

One thing I think I would really like about choosing her is that she does group prenatals. All the women due around the same time meet together once a month for two hours (then once every 2 weeks after 36 weeks). The midwife or one of her assistants has a discussion topic or presentation. There's time to chat and to have one-on-one visits with the midwife, too. I feel fairly isolated here, having moved recently and having no friends nearby. This would give me some much-needed socialization and birth talk!

For the moment I am leaning towards going with her and staying open to what I feel is right on a spiritual and intuitive level. It is, admittedly, a little bit strange to be looking into midwives after having done it unassisted. It's not that I worry about my ability to give birth or to recognize and address situations in labor. I also don't want emotional support or coaching during labor. I just want more options at my disposal. I think, also, that I feel a bit more fear this time around. Not about the birth or anything; just in general, knowing how much I love Zari and, as a mother, how much I have to lose (as well as gain).

So that's where I stand at the moment. My pregnancy is going very smoothly. I started feeling better about four weeks ago; the dizziness and queasiness gradually subsided and now I feel totally normal again. And food tastes good again! How lovely...I lost a few pounds since becoming pregnant, although that might be as much related to my exercising regularly since I got back from France as to my lack of appetite. Plus those pounds aren't really "lost" since they were "gained" back after I ran a half-marathon last fall (not immediately after the race, of course, but over the course of the winter since I stopped running after I accomplished my goal and--lame excuse?--I don't enjoy running in cold weather). I am almost 3 months along at this point and look forward to all of the fun parts that are coming: feeling the baby move, finding the heartbeat with the fetoscope, watching my belly grow.
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Pregnancy, Childbirth and Mothering Conference

I just received notice of this one-time conference to be held this coming spring at the University of Oregon:
Philosophical Inquiry into Pregnancy, Childbirth and Mothering.

The conference will be primarily philosophical in focus, but we also invite interdisciplinary scholarship from fields outside of philosophy including, but not limited to, sociology, psychology, women’s and gender studies, and health care related fields.

May 14-16, 2009
At the University of Oregon

Keynote Speakers:
Eva Kittay, State University of New York at Stony Brook
Lisa Guenther, Vanderbilt University

Invited Speaker:
Andrea O’Reilly, the Association for Research on Mothering, York University

Call for Papers:
Submit abstracts for papers or panels.
Approximately 750 words.
Due January 31 at 5pm.
Email submissions or questions to :
Include a cover sheet with name, institution, department, & contact information.
Document should be submitted in MS Word (.doc file).
For additional information please click here.
Anyone who would like to receive a poster or postcard version of the CFP can email
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Monday, October 20, 2008

New York pictures

Museum of Natural History
Waiting for the subway train
Fooling around with Eric
Random people doing random things in Manhattan:
Bike polo (crazy costumes a must)
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Sunday, October 19, 2008

Colin Powell backs Obama

One of the most articulate explanations I have ever seen about the two presidential candidates' attributes and approaches:

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Saturday, October 18, 2008

Alberta to fund midwifery care

This news release just came in: Alberta will fund midwifery care province-wide starting in April 2009. Women will be able to give birth in their preferred location: hospital, birth center, or home.

Alberta expands health care coverage to midwifery
October 16, 2008

Expectant mothers will have more choice and improved access to care

Edmonton... The Alberta government is improving access to maternity services by bringing midwives fully into the publicly funded health system. Effective April 1, 2009, expectant mothers who choose to have their babies with the assistance of a midwife will have that service covered.

“This decision will provide better access and more choice for expectant women and will relieve pressure on doctors, nurses and hospitals,” said Alberta Health and Wellness Minister Ron Liepert. “Expanding the use of midwifery services will also help address the pressures on family physicians and obstetricians and meet the goal of introducing new service delivery models as outlined in the Health Workforce Action Plan.”

With this change, expectant mothers will have access to innovative, publicly funded midwifery services in a variety of locations including hospitals, community birthing centers, or in their homes. Services will be accessible across the province, in accordance with midwifery guidelines.

The Alberta Health Services Board will receive $4 million for midwifery service implementation across Alberta in the 2009-2010 fiscal year.

The Alberta Health Services Board in conjunction with Alberta Health and Wellness and the Alberta Association of Midwives will develop and establish a structure that provides full midwifery services to all Alberta women with low-risk pregnancies. This service will emphasize various options for expectant mothers; foster collaboration between midwives, physicians, nurses and other health care professionals; and create a sustainable model for the future.
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Monday, October 13, 2008

A word of advice

If you decide to have a cesarean section for breech presentation, insist on an ultrasound to confirm the position right before surgery. Otherwise you might end up with a c-section, only to discover the baby was in fact head-down. A L&D nurse tells of one such "surprise vertex" that recently occurred while she was on shift.

Another piece of advice for those who would accept a cesarean for breech presentation: insist on waiting for labor to begin, rather than scheduling the surgery in advance. That way you know the baby is ready to be born, and the baby can even benefit from some early labor. And of course, you might just be surprised to discover that the baby has turned around!
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More on Laila Ali

Finally, I found a short interview with Laila Ali about her birth experience. She's motivating me to keep going to the gym. I usually go three times a week and do 30 minutes of elliptical and 10 minutes of rowing. I'd like to add some weight training, as soon as I get my courage up to master all the weight machines.

Watch CBS Videos Online
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Sunday, October 12, 2008

Midwife-led care

Want to decrease the likelihood that you'll have an episiotomy, an instrumental delivery, or use pain medications (both IV narcotics and epidural/spinal anesthesia) during labor? Want to reduce the need for hospitalization during pregnancy? Want to increase the odds that you'll have a spontaneous vaginal birth, that you will feel in control during labor and birth, that you will know the birth attendant actually present when you go into labor, and that you will initiate breastfeeding? Want to reduce the chance that you will lose your baby during the first 24 weeks of gestation? Want a shorter hospital stay for your baby? Want all these benefits, with no increase in overall fetal or neotatal death rates?

Choose a midwife!

The Cochrane Library just published results from 11 trials, totaling 12,276 women, of women randomly assigned to midwife-led care, versus other forms of care (care with family physicians or obstetricians, or shared between several health care professionals). In other words, these studies were not of women who self-selected midwives to care for them, but of women who were randomly assigned to either group. They found a host of benefits to having a midwife as the primary care provider, with no identified adverse effects.

I haven't yet downloaded the full text of the study, but I assume that the midwife-led care in the trials was entirely or primarily hospital-based. In other words, these benefits apply to the 98-99% of women who choose hospital birth in North America and other industrialized countries, not just to the 1-2% who choose home birth or birth centers.

Here is a "plain language summary" of the Cochrane findings:

Midwife-led versus other models of care for childbearing women

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.
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Another controversial photo of public breastfeeding

And she's even nursing a different species...

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Saturday, October 11, 2008

Straw bale barn

I drove out with a friend this afternoon to help build a straw bale barn at an organic farm. It was a small post-and-beam building (made mostly out of salvaged lumber from old barns) with straw bale infill walls. We arrived after the bales had been stacked, so we helped fasten the chicken wire onto the bales and apply the first layer of stucco. It was a beautiful fall day--hot, actually. If I ever build a new house, I would definitely consider doing straw bale construction. It's inexpensive, uses mostly local materials, and is very energy efficient.

Front of the barn
Side of the barn
The foundation was made of layers of old tires filled with gravel
Interior, showing the post-and-beam construction.
You can see the old pegged mortise & tenon joints from the original barn framing.
The upstairs is a hayloft, so about 1/3 of the ceiling is open to the attic floor.

Wetting the straw and applying stucco
(a mixture of sand, Portland cement, nylon fibers, and a few other additives)
First layer of stucco
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Angelina Jolie breastfeeding

Angelina Jolie is featured on the cover of November's W magazine breastfeeding one of her twins. The UK's Daily Mail talks more about her decision to become pregnant with her three children and about the photos in W magazine. The cover photo has become the subject of gossip and controversy around the web. Although most people find the photo beautiful and are glad to see breastfeeding portrayed in such a lovely way, some have got themselves into a tizzy because you know what she's doing with her breasts and we shouldn't have to see that in public. Never mind that you see less in the picture than you would at the public swimming pool or on the cover of a fashion magazine...just the idea that there's a baby sucking on her breast is apparently too scandalous for some people. I love the picture, especially the little hand waving around while she nurses.

Here's the picture in question (from the Daily Mail article):

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Thursday, October 09, 2008

A Canadian on Obama

No, it's not a famous Canadian figure--it's my brother-in-law. He and his wife are both PhD students in political science at Duke, and I love hearing what they say. Here's his take on why he supports Barack Obama (even though he can't vote). With all of the emotional appeals left and right, I enjoy hearing someone step back and calmly analyze the candidates' leadership styles and stands on certain policy issues.

Your thoughts?
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Wednesday, October 08, 2008

Millbank Report on Evidence-Based Maternity Care

Two articles just came out in USA Today about the rising costs of maternity care and about evidence-based solutions to the high levels of unnecessary interventions and procedures performed during labor and birth.

Study: High-tech interventions deliver huge childbirth bill
Maternity-care failings can be remedied with cost-saving fixes

The findings come from a
report, Evidenced-Based Maternity Care, issued jointly by the Milbank Memorial Fund, The Reforming States Group, and The Childbirth Connection. You can download a PDF of the report or request a free printed copy.

From a summary of the report's findings:
What are the key findings of Evidence-Based Maternity Care?
Despite good intentions of many dedicated health professionals and very large expenditure of resources, the U.S. maternity care system has many shortcomings. Many women and babies receive poor quality maternity care, including many procedures, drugs and tests that are not needed -- "overuse" -- and failure to get many beneficial forms of care -- "underuse". Thus, overall national performance on many quality indicators is poor when compared to the benchmarks of high performers in the United States and achievements of many other affluent and less affluent nations. In fact, important indicators such as low birthweight and preterm birth rates have been worsening for decades.

Poor quality care and unacceptable health outcomes affect a very large population -- there are over 4.3 million births in the United States every year. And they impact babies during their most sensitive and important period of development and younger, primarily healthy women.

Further, private insurers (covering 51% of all births) and Medicaid programs (covering 42%) are getting poor value for their considerable investment in maternity care. This translates to wasted resources for taxpayers, employers and families themselves. Maternity care plays a major role in the health care system. Hospital charges for mothers and babies far exceed charges for any other condition, and cesarean section is the most common operating room procedure in the country.

However, there is good news: a large body of rigorous systematic reviews is available now to point the way toward improved care, health and use of resources. The Evidence-Based Maternity Care report (PDF) highlights best evidence that would have a positive impact on many mothers and babies and would improve value for payers. The report also identifies barriers to providing evidence-based maternity care, and presents policy recommendations to address the barriers.

What are top implications for policy makers, childbearing women and maternity professionals?
Policymakers can play an important role in improving quality, health outcomes and resource use by addressing by barriers to evidence-based maternity care. Recommendations for addressing barriers in the new report (PDF) fall in four areas: measuring performance and leveraging results, fixing perverse financial incentives, educating the key groups, and filling priority research gaps.

Childbearing women need to understand that maternity care that is routinely available often is not in the best interest of themselves and their babies. Pregnant women have the right and responsibility to become informed and make wise choices -- for example, their choice of caregiver, birth setting and specific procedures, drugs and tests. Becoming informed and taking responsibility can be a big task -- and can have very big pay-offs.

Health professionals need to recognize that usual ways of practicing frequently do not reflect the best evidence about safe, effective maternity care. The field of pregnancy and childbirth care ushered in the era of evidence-based practice: many hundreds of currently underutilized systematic reviews point the way to improved maternity practice and outcomes. The Evidence-Based Maternity Care report (PDF) identifies dozens of reviews that are relevant to care of a large segment of the maternal-newborn population. Engaging with the unparalleled move for health care quality and patient safety can improve professional performance and satisfaction and reduce risk of liability.
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Wednesday, October 01, 2008

Laila Ali update

Five weeks ago Laila Ali had her baby boy. In the announcement there was a vague mention of "surprises" and a "change of plans" about her home birth. I was curious to know what had happened--breech presentation? complications during labor? I just read more about the birth today. She was induced at 39 weeks for suspected growth restriction (although with her baby weighing 6.8 pounds, it doesn't seem that serious). Fortunately all ended well. She had a 15-hour labor, a vaginal birth, and a healthy baby. And isn't the new family beautiful?
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Going to NYC!

We're taking off early Friday morning for a long weekend in New York City. Eric is going to The New Yorker conference. I had enough frequent flyer miles from our nine summers of traveling to France to get a free round-trip domestic ticket. Zari, of course, is coming along. She's been talking a lot about airplanes over the past few days. We're staying with chou and her husband. They used to live near us and recently moved to Brooklyn so she can do a PhD in food studies. I anticipate four days of great food & conversation!
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